2018 Mother-Daughter Retreat
Please fully complete this registration form! If you have any questions, please call our Program Director, Christa, at the Agapé office (919) 552-9421.

If you are having trouble moving between fields on the form, use the "tab" key to navigate to the next section.

After submitting this registration form, you will be offered a link to pay online via credit/debit card. A check can also be mailed to Camp Agapé. Checks can be made out to "Agapé Kure Beach Ministries" and mailed to 1369 Tyler Dewar Ln, Fuquay Varina, NC 27526

Email address *
Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Additional Phone Number
Your answer
Address *
Your answer
City, State *
Your answer
Zipcode *
Your answer
Home Church
Your answer
Other participants names' listed *
Please put children's ages after names or designate as adult
Your answer
Number of Participants under age 3 (free) *
Your answer
Number of Participants ages 3-12 ($65) *
Your answer
Number of Participants over age 13 ($95) *
Your answer
Special needs or dietary concerns
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Agape Kure Beach Ministries, Inc.. Report Abuse - Terms of Service - Additional Terms